Injury and the effects on mental health

This is going to be more of a 'getting it off my chest' post rather than an advice post, but hopefully some of you may get where I'm coming from.

I started running 3 years ago, I've run a few half marathons and decided earlier last year I wanted to do a marathon this year. I wasn't able to get a VLM place but settled for my local marathon in Belfast (1 May).

Training was going well - I managed up to 18.5 miles 4 weeks ago then went on holiday. No problems taking a break from serious running because I was nicely ahead of schedule. My first run away, I ran on the beach - with quite a severe slope. Stupid me, ran on it feeling the pull on my right foot. Just a slight niggle, so ran another couple of footpath runs whilst away. Came back home, did a LSR and was in agony. Went to physio who said it was a pulled ligament at the side of my foot near the heel - about 4 weeks before I can run again, but she was hopeful it may be sooner...

Well, 10 days into recovery and I'm still not walking properly and I'm beginning to see the marathon slipping away...

And so the point of my post...having a history of depression for much of my adult life, I don't think I realised just how much running was keeping me on an even keel mentally. I can honestly say in the last 3 years, my mood has remained fairly even. When I felt a bit crap, I went for a run; even planning and organising my running has kept me from feeling negative about other things in my life. Now, the old negative thinking has started to creep in, I feel as if i'm going to burst into tears any minute and I feel a little out of control; the lay off in running has exacerbated my slightly lower mental health state due to other things going on in my life. Although, it's hard going at the minute, I am going to the gym 3 times a week and I cycle to work each day, so I know my cardio fitness isn't suffering and it gives me some sort of hit of endorphins. However, as most of you will know, it's not quite the same.

Despite this, I'm trying to look at the positives. I have GNR to look forward to in September (although I'm worrying that if the injury lingers then that too might be in jeopardy). I can also take this year to work on my strength and flexibility to reduce my injury risk next year and try again for the marathon.

Has anybody else experienced similar when injured, especially with a history of any mental health problems? I can honestly say at the moment, running has been my anti-depressant, so it's just a case of managing and making do until I can run again, hopefully very soon.

Comments

Hi @happybunny ,
It's definitely not just you! There is a lots of research coming out about the link between pain and depression and particularly, the effects of not being able to exercise to the level you want to.
There is a really strong link between running and mental health, so it's not surprising that you're feeling down now that you're not able to.
It sounds like you're doing exactly the right things by going to the gym and cycling to keep you're fitness up. Have faith in your physio and may sure you work hard at the rehab.
One thing I would suggest is maybe replacing your runs at the moment with a ride or a swim? I know you said you're cycling to work, but it's not the same as going out for enjoyment as you would for a run. It might help replace some of those endorphins!
I hope that's been some help, and hope you're back running soon!

Yes, I've read quite a few articles over the last couple of years as to how running can help depression, just a shame that injury can then be a setback

The gym sessions have really replaced my running - I even went on Sunday and got up at my normal LSR time of 6am to eat my porridge to do 2 hours on the X trainer!

This weekend will be tough as I'm over at my parents in England and had registered to run the local half marathon on Sunday.

I'm not really a keen cyclist (it is just purely a mode of transport for me), but I asked the physio last night if i can walk, and she suggested 30 minute slow walks should be ok. Walking is as close to running, as far as mental health benefits for me, so providing it's not too painful, I'll get out walking over the weekend.

When I was pregnant I had to give up running due to problems with my pelvis and then I had to wait to start running again as I had a C-Section. I have not suffered from issues with mental health but I can tell you that Iwas at my lowest during that time. If I saw people running as I was driving to work I would be in tears and there was nothing I could do about it. I took up swimming which helped but it has never been the same as running. The thing is people who don't run just don't get it. They think we're all weird for enjoying running to begin with and that we should be happy to be not running. All I can say is work hard at your recovery and do exactly what the physio advises. Best of luck and I hope you recover soon.

You have my utmost sympathies. I have been grounded for 8 weeks with various things going on in my ankle and only just resuming gentle jogs this week. I have spent a year on the bench when trying to address achilles tendinopathy and had to really delve deep to identify what I could substitute. I horse ride, swim, cycle, do barre, pilates and yoga. As well as walking the dogs. But I can honestly say they are all poor substitutes. I am convinced that running alters our brain waves and chemistry in such a unique fashion that it cannot be replicated. And I truly believe, once a runner, always a runner.

I have been fortunate not to suffer from ailing mental health but, like all of us, I have had challenges in life, and I also do have friends who have turned to running to help their depression. Every single one of them says it has helped them get off the medication. The body is a powerful tool if used consciously.

Here is my three pronged approach to get you through this time:

1. Running is a habit. Sudden cessation of any habit whether it is behavioural or chemical takes time. Be kind to yourself. Go for a pedicure. Watch a film that makes you laugh (Bridget Jones' Baby perhaps?) Give yourself time to switch out of your running habit while you allow yourself to heal. Injuries are our best teachers as they tell us what is going wrong with our physiology. Listen to your body and treat this rehab time as you would your training and be diligent about staying on task. Stepping stones back to where you want to be.

2. Change your mindset. As running is a habit (see point 1), we can plan our lives according to future races and weekly training schedules. This gives us a high degree of certainty and satisfaction in achieving mini goals as we strive towards a larger target. It is human nature to feel happy when in a routine. Much as some say they like variety, I think they overlook the routines in their day that keep them grounded, e.g. mealtimes, order of tasks on waking (brush teeth, eat breakfast, feed dog etc). These all give us a sense of order and calm. Try create another daily/weekly habit to keep you grounded in the same way. I get the sense you are grasping for that alternative but it will come in time if you set an outline of your weekly movements to include cycle commuting, gym work and perhaps something at home such as yoga or pilates on youtube. After a while, the routine will be comforting (although I won't pretend you won't want to punch any random runner you see out in public). Take each day at a time. Don't look beyond the day ahead of you because you won't know where your recovery is taking you until you are there.

3. Grab the opportunity. All runners admit they don't spend enough time doing the things they know they should that would benefit their running. Yoga and pilates are my go-to conditioning activities and there are days when I don't do it at all because of the running. During the past 8 weeks, I could only do that and my body is so much stronger as a result. So now I am keeping it up as a non negotiable daily activity before I can run. If you develop good habits to incorporate the cross training and strength work that is crucial to being a strong and injury-free runner, you can continue with them when you are back running and will be glad you had the chance to do this. See it as a silver lining to the otherwise dark cloud.

I know it is hard. I know I am not speaking from the same place as you. I wish I could help you keep the black dog at bay. But perhaps taking control in the way I have suggested might help you feel less helpless at the moment. Above all, be patient with yourself, both mentally and physically. Of course you will feel down and like your fitness is slipping away. Who wouldn't when injured? But you can take steps to mitigate the effects. Sending hugs.

@Elizabeth Dix 4 You're so right about non-runners not quite getting it. I think that's why I felt compelled to have a bit of a vent on here. My colleagues at work, are lovely and have been asking about my foot and how it's going, but they're unaware how it's been effecting my mentally (which is probably my fault as I'm quite a private person). I do hope you're up and running now yourself?

@MsE you offer very sensible and thoughtful advice The gym has become a new habit for the time being, but I agree that this is definitely a good opportunity to look at how I can look at other opportunities. I agree that yoga/pilates are great conditioning for running. I started a gym balance class which incorporates some of these back in November to supplement the marathon training, although it's fallen by the weigh side as it clashes with physio at the moment. I would like to try and do some at home to, as my weak links are definitely my ankles and feet (including my lack of balance!).

All your words have really helped and I do feel more positive since posting yesterday. If anything, this experience has taught me just how much running is a part of my life and how much it has (and hopefully will) help in the future.

I am running distances of up to 10km now and take part in triathlons, I have my first Olympic Distance in August! It really surprised me how the injury impacted me mentally and emotionally and made me really appreciate the link between exercise and mental health. I am definitely a happier and nicer person to be around when I'm running and exercising regularly!

I practice yoga and one of my teachers has a youtube channel you may find of interest, search for jaynebeccayoga. I think she is really good and also speaks a lot of sense when it comes to accepting the limitations of our bodies. She has certainly helped me accept the limitations of my post baby body.

I wish you a speedy and successful recovery and look forward to hearing when you are back up and running.

I know exactly how you feel. Having had a major depressive episode five years ago which resulted in 17 months of NHS mental health therapy (first appointment 2.5 hours after I saw my GP) I have taken my black dog for runs to tire them out. I am off running at the moment, same as you I was training for a marathon, looking at hip surgery and seeing a consultant in a weeks time to find out how bad it is. So strategies I have used (and I realise these may not be helpful). Every day is planned, I know what I am doing where, when and how. It is the routine which helps. I am swimming (80 lengths at the moment), it makes me feel as if I am doing something. I have to plan something everyday which makes me smile! This can be watching the sun rise, reading a book, meeting a friend, sitting on the sofa reading trashy novels, anything which makes me smile.

I am planning my return to running (which could be 18 months away), that means keeping myself strong so body balance and gym work is key. Yes there are days when I want to put my head under the duvet and cry. My mental health team said sometimes it is better to do this then move on, so I do.

I also keep a diary and have to look for something at the end of everyday which has gone well, makes a massive difference to me. Also the book the curse of the strong is a good read.

I can only say I hope you feel better soon, it is tough, but we are here for you. Happy to speak more if you want to PM me.

@Elizabeth Dix 4 so glad you are and good luck with the Olympic distance! I checked out that yoga channel and have saved a few of the routines to do when I get home.

@TT I love your phrase "I have taken my black dog for runs to tire them out". It's a perfect way of saying how I deal with my black dog. I had a whole lot more typed, but auto save didn't seem to save before I posted my message. But to summarise what I was trying to say, most of my major depressive episodes were during my teens and 20s. In my 30s I found that focusing on goals that were hard enough but achievable, helped the negative thinking. Running turned into a real leveller. Your positivity is really humbling and I thank you for your thoughtful response.

I started running almost a year ago precisely to help tackle my own depression on suggestion, since then I've had a couple of injuries which have stopped me. The shorter periods (2-3 weeks) were manageable. Right now though I'm not in a happy place having not run since mid Jan. The link between mood and running specifically is clear to me. I completely understand you crying or almost crying when seeing others run, I get the same, but also when sat at my desk at work or on the couch at home. I can't actually motivate myself to do other exercise, although I've kept to my rehab (as much as possible) and done bits of strengthening work.

Hi slowfoot, my first experience of exercise after my breakdown was to map out a walk round the block. It was less than 2/3 of a mile and it took me 20 mins. I had to sit down on a neighbour's wall half way round. My challenge was to do it the next day. Slowly (over six months) I went further and further. I just lay out my kit the night before and go for a walk first thing, like you off running at the moment. It is tough, I want to put my head under the duvet, but most days I am out there. I also see a trainer at the gym one morning a week, I have to go to that!

I know the stronger I am before surgery the quicker I will be back to running (if I end up with surgery). Knowing that helps me but it is not easy. One day at a time........

My upmost sympathies - that must be tough going to have not run since January. I actually feel a bit of of an idiot getting so down about it, as I really do think this will only sideline me for another week (wishful thinking?), but one of the symptoms of depression (as you probably well know) is lack of perspective.

I've found over the last week or so that, lowering my expectations and focusing on what I can do have kept me from spiralling. First, I had to accept that I would miss a half marathon last weekend, and I'm preparing myself that I may miss the marathon in May (although I'm not ruling it out completely). Fortunately, I'm a (reluctant) member of a gym. So, I've tried to swap my runs with the cross trainer. I think, as has been said before, routine is key. Best of luck!

TT - one day at a time is a good way to look at things. I don't have an issue with running when not injured, it's doing anything else that's the problem.

happy bunny - I've already written off a 10k last weekend and my next event would be in about 2-3 weeks time, a 10 mile. That was the event I was most looking forward to do. I've accepted that I won't be able to put in a respectable time but would still hope to do it as a LSR. Go/no go decision at the physio the week before. I've actually sprained 3 ankle ligaments, 2 are good to go but a deltoid is being an awkward fucker and I'm still only testing it, although I've got clearance to start building mileage. As you say routine is important, I have Asperger's Syndrome and routine is something I find particularly important, it's establishing it that becomes the problem particularly when depression saps your desire to do anything.

Hopefully it will all come together. Thanks.

I hope you're good for May, I hope your injury is not the same as my remaining one as it's being stubborn especially for what can only have been a mild sprain I can trace it back to 11th Jan, and seriously exacerbated on 4th Feb.

@Slowfoot hope you're able to do the 10 miler. Forget about PB's at the minute- they'll be other races - treating it as an LSR will be the way to go. Certainly having Aspergers as well must exacerbate the depression when injured. I hope you can devise a new routine to help.

I had the go ahead on Tuesday from the physio to start gentle running. I went out today for a 3 mile run/walk and it seems OK at the moment, but if I'm looking at still doing the marathon I need to take the very quick leap to longer runs quite soon to get back up to somewhere near, so the risk of re-injury is quite high. Fortunately, this week has definitely helped my mood, but I think it could be a rough few months ahead with things that are going on - I could really do with being able to keep running

Take care of yourself and feel free to keep chatting on this thread / PM if you want.

Slowfoot - I hope you don't mind me piping up. You sound like you have a mixture of goals and I wonder if setting an order of priority might help you mentally come to terms with how your injuries are restricting you?

I feel your pain as I am currently dealing with three issues in my right ankle: a completely ruptured ligament, a partially torn ligament and anteromedial impingement (a bone spur). It is the first and last issues that have stopped me training and racing and will need surgical intervention. Anyway, being cautious with ankle sprains is what I wasn't, which landed me in the position I am in now, so don't rush in.

I know it must seem ages since it all first started but that can also be a sign you need to slow it all down and adjust your expectations. You aren't giving your body time to heal. For me, an approaching race date can give additional pressure and work against me getting over injuries properly. As happy bunny says, you could forget the PBs (or even races, after all there are plenty of others). Then focus on what you can control, such as alternative activities that won't impair recovery and will give you some relief.

I do understand that your Aspergers can drive you to keep routine but highly structured routines similar to running, such as swimming, can also be brought in as a habit and give the same relief. Might that be an option to incorporate and take the pressure off the ankle?

I've not run since November, and have no signs of running any time soon. I have had several mis-diagnoses, but last month my MRI showed i have two stress fractures in my foot (including a navicular SFX). I'm doing everything the consultant told me to do but I feel it's not really healing and like I said, I have very little hope that I will be running again this year. I'm not sure I'm convinced ever at this point!

Like many of us here, I have used running to keep off depression, so the past few months have been tough. I was doing ok (I've been injured before and I knew I would heal) until my MRI results and my brain has gone into meltdown. I had to cancel a holiday too (which was pretty heart breaking). I just feel this is it now and despite going to the gym most days nothing is really helping.

I had no idea how much I had let running define who I was - and I think this now causes problem.

It's really difficult, and unless you experience this, people just don't understand!

So I'm not offering much here but I do understand and you're not alone.

You're all obviously right, plenty of other races around I'm 90% going to drop the 10M right now. I ran on Wednesday 0.8 miles and was fine, did 0.7 on Friday and had to stop due to a bad feeling in my ankle which then started hurting as I walked back home, was fine by the next day did another 0.7 today and more or less fine but no confidence to go further at the moment :(. Maybe I should take up sprinting...

The reason for me posting here was to try and help rediscover my motivation, not quite there yet but improving.

@TheSianz I really hope this isn't the end of your running career. What did the dr say in terms of recovery? Trust in what your consultant says though, as although I have no experience of stress fractures, I know that these can take some time to heal properly, and managing your expectations in terms of how soon it'll be before you can run is probably the best way forward. The only real advice I can offer is finding the alternatives and do what you can now to become a better runner later when you can run again. I hate the gym. I'll be honest but I also know now the benefits of having some kind of strength and conditioning training. When you go to the gym are you doing workouts yourself? The reason I ask, is that I really don't have much of an idea what I'm doing at the gym i.e. how to use the different equipment etc, so I haphazzardly just do 'whatever' and, whilst I was injured, did mainly the cross trainer. What I find helps me is doing some of the organised classes that our gym offers, which incorporate strength training and conditioning. I went again last night for the first time for weeks, and I ache today so I think it's really had a benefit!

You're right - like you, I think I've found the downside of running, in that I've become so reliant on it sustaining my mental health that injury has exposed the lack of a back up.

@Slowfoot not required to forget my injury (still a dull ache in the background) or this thread. We could rename it 'those of us who run to tame the black dog, and other running tales'

Slowfoot, if it has not gone in eight weeks then you need to think about seeing a medic. They might not be able to do anything but at least you will know if it is something more serious. Like the Sianz I am out for the long run! However I know what is wrong and it can be fixed. I would suggest you download the NHS (assuming you are in GB) pain chart and be honest. What I thought was a 2/3 was actually a 7! As I said to my GP running makes you have a different perspective on pain. Any news is good because you will know what you are dealing with.

I agree with everyone about the benefits of running in relation to mental health,but we should all remember to work on our mind attitudes at the same .Try to cultivate a more forgiving outlook with more gratitude and positivity towards your life in general.It can be done in small steps ,just like running and benefits are enormous.

Hi @Slowfoot I'm going to echo what TT has said and maybe get another opinion on the ankle. Funnily enough, in regards to eating my eating habits have been dreadful, again I tend to eat crap when I'm feeling low, which was ok when I was doing the mileage. Don't dwell on what you've done/not done.

Running wise, things were picking up. Got back doing a few short runs, then did a 10 miler on saturday. Foot was fine, but now my groin's playing up. Pain has gone today but I feel it and haven't run since. Booked a sports massage for tomorrow, as I think part of teh problem is that my legs just feel really tight and tense. After tomorrow, I can see what running I can do the rest of the week - I was hoping to extend my LSR to 13/14 on Sunday - time will tell!

Mood wise - pretty up and down, which seem to change with moments of 'I can still run the marathon' then other times where I don't think I will be able to because of injury/lack of preparation.

@happybunny glad to hear your mileage is getting up there. Hopefully the tightness is just a symptom of a lack of running and a bit of stretching and that massage will put you right.

I was really down on Saturday and did speak to my physio over email. I've spoken to my GP (lucked in on a cancelled appointment today) and going for an X-ray tomorrow. Reading around deltoid ligament injuries are often associated with more serious trauma so he wants to check for a stress fracture.

I'm a little shocked looking back on the weekend on how badly this set back effected me.

@TT thanks for the thought on the pain guide, it is much higher than I would have thought. I can communicate that and hopefully be treated more seriously.

@Slowfoot really glad this is being looked into further - half of the battle is getting a diagnosis and a timeframe - I think not knowing makes it harder to manage expectations. It's good that you can get some advice from the physio as well. Good luck with the xray and let us know how you get on.

Not looking forward to sports massage today - never had one before and hear they can be a little on the painful side but I don't care as long as it improves things and I can get a bit of advice to maybe see me through to the marathon.

@TheSianz I really hope this isn't the end of your running career. What did the dr say in terms of recovery? Trust in what your consultant says though, as although I have no experience of stress fractures, I know that these can take some time to heal properly, and managing your expectations in terms of how soon it'll be before you can run is probably the best way forward. The only real advice I can offer is finding the alternatives and do what you can now to become a better runner later when you can run again. I hate the gym. I'll be honest but I also know now the benefits of having some kind of strength and conditioning training. When you go to the gym are you doing workouts yourself? The reason I ask, is that I really don't have much of an idea what I'm doing at the gym i.e. how to use the different equipment etc, so I haphazzardly just do 'whatever' and, whilst I was injured, did mainly the cross trainer. What I find helps me is doing some of the organised classes that our gym offers, which incorporate strength training and conditioning. I went again last night for the first time for weeks, and I ache today so I think it's really had a benefit!

You're right - like you, I think I've found the downside of running, in that I've become so reliant on it sustaining my mental health that injury has exposed the lack of a back up.

I think the consultant is a bit confused/not sure what to do! I actually went in again this morning - had another x ray. Been told to stay in the boot another 2 weeks then I can try 2 weeks out of it to see how it goes. It's all up in the air at the moment.I am trying to take a day at a time. I definitely need to find more outlets! Now the weather has gotten nicer, in a way I feel worse because I want to be outside and running up mountains!I also hate the gym but i'm glad of it. I'm doing rowing and biking and weights. I go on my own and kinda try and have a bit of a routine to follow x this day, x that day etc. I'm worried about going to classes, in case it's more than I can manage on my foot! I think my overall fitness isn't too shabby considering I've not run since November, I have felt a bit fitter if anything, as I've been able to do longer workouts etc. and my biking is coming along well. What I find really hard is I want to be planning trips and adventures and I feel I can't!

I think what also impacts me mentally is wearing this boot because its such a ruddy large cumbersome thing, and people often say things and stare (dunno why its not THAT strange) and it makes me feel a bit weird.

Cannot recommend pool running enough (although you may want to check it is OK with the water pressure on your foot before trying it, Sianz). Here is an excellent schedule to take you through 9 weeks of training. It is efficient and you can do consecutive hard workouts without any issues relating to impact. http://kemibe.com/distancecoach/labreports/water.shtml

Don't be intimidated by it, TT. It is just numbers but actually very easy to do, very quick and very effective. The article outlines the approach and mindset very clearly too. And, for those who flounder (no pun intended! ) without a schedule, it provides an excellent schedule to keep you moving forwards. My tip: do buy a flotation belt to help you float so you can focus on trying to run rather than not drown.